Behavioral Science: Schizophrenia 1 & 2

Question 1

Schizophrenia general features

Answer 1

• psychosis is a hallmark symptom
• may present as alterations in sensory perceptions (hallucinations), abnormalities in thought content (delusions), of abnormalities in thought process/organization

Question 2

illusion definition

Answer 2

misperception of real external stimuli

Question 3

hallucination definition

Answer 3

sensory perceptions not generated by external stimuli

Question 4

ideas of reference definition

Answer 4

false conviction that one is subject of attention by other people, feeling as though people are referring to you in their conversations

Question 5

delusions definition

Answer 5

false beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by culture
- MC delusions of persecution

Question 6

loss of ego boundaries

Answer 6

not knowing where one’s mind and body end and those of another begin

Question 7

alogia

Answer 7

lack of informative content in speech, poverty of speech

Question 8

echolalia (clanging)

Answer 8

repeating statements of others/associating words by sounds, not meaning

Question 9

thought blocking

Answer 9

abrupt halt in the train of thinking, often due to hallucinations

Question 10

neologisms

Answer 10

inventing new words

Question 11

circumstantiality

Answer 11

in responding to questions, one presents unnecessary add voluminous details ultimately arriving at an answer to the question

Question 12

tangentiality

Answer 12

beginning a response in a logical fashion but then getting further and further away from the point, failing to answer the question initially posed

Question 13

loose associations

Answer 13

loss of logical meaning between words or thoughts, when asked a question, illogically jumps from one subject to another

Question 14

DSM5 criteria for schizophrenia

Answer 14

A. Characteristic symptoms: 2 or more of the following, each present for a significant portion of time during a 1 month period (less if successfully treated):
- delusions, hallucinations, grossly disorganized or catatonic behavior, negative symptoms, disorganized speech

B. Social/occupational dysfunction: one or more major areas of functioning are markedly below level achieved prior to onset

C. Duration: continuous signs for 6+ months, with at least 1 month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms

D. schizoaffective and mood disorder exclusion

E. substance/medical condition exclusion

Question 15

Positive symptoms

Answer 15

Additional to expected behavior

ex. delusions, hallucinations, agitation, talkativeness, thought disorder
- respond well to most traditional and atypical antipsychotic agents

Question 16

Negative symptoms

Answer 16

Missing from expected behavior

ex. lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming, impoverished speech
- sometimes better response with atypical antipsychotics

Question 17

3 phases of schizophrenia

Answer 17

Prodromal, psychotic, residual

Question 18

Prodromal phase

Answer 18

Prior to first psychotic break
- avoidance of social activities, quiet and passive or irritable, sudden interest in religion or philosophy, physical complaints, anxiety and depression

Question 19

Psychotic phase

Answer 19

Loss of touch with reality

- Associated with positive symptoms

Question 20

Residual phase

Answer 20

Period between psychotic episodes. In touch with reality, but doesn’t behave normally.
- Negative symptoms, peculiar thinking, eccentric behavior and withdrawal from social interactions

Question 21

Genetics of schizophrenia

Answer 21

• twin studies support role of genetics

- advanced paternal age? –> de novo mutations in paternal germ cells

Question 22

Gender differences in schizophrenia

Answer 22

• occurs equally in men and women
• onset: 15-25 years in men, 25-35 years in women
• women respond better to antipsychotics, but greater risk of tardive dyskinesia

Question 23

tardive dyskinesia

Answer 23

• cumulative days of D2 receptor drug blockade can lead to permanent movement disorder, choreic movements

Question 24

Environmental factors leading to schiz

Answer 24

• viral infection and exposure to drugs during development
• increased incidence when born in cold-weather month, possibly due to viral infxns?
• 3rd trimester maternal use of diuretics
• In adults, anti-NMDA receptor antibodies?

Question 25

Neurological abnormalities in schiz

Answer 25

• Decreased use of glucose in prefrontal cortex (hypofrontality)
• lateral and 3rd ventricle enlargement
• loss of cerebral asymmetry
• decreased volume of hippocampus, amygdala, parahippocampal gyrus
• decreased alpha waves, increased theta and delta waves, epileptiform activity on EEG
• abnormal eye movement

Question 26

What regions of the brain are hypoactive and hyperactive in schiz?

Answer 26

Hypoactive: dorsolateral PFC
Hyperactive: ventromedial PFC

Question 27

Role of dopamine in schiz

Answer 27

Excessive DA activity in mesolimbic tract

• stimulants can cause psychosis by amplifying this tract
• negative symptoms may involve a diff abnormality, perhaps hypoactivity of mesocortical tract
• elevated levels of HOMOVANILLIC ACID (metabolite of DA) in bodily fluids of pts with schiz suggest inc. DA activity and use in CNS

Question 28

Role of serotonin in schiz

Answer 28

Serotonin hyperativity

• hallucinogens which increase serotonin cause hallucinations and delusions
• atypical antipsychotics have anti-5HT2A receptor activity

Question 29

Role of norepi in schiz

Answer 29

Possible hyperactivity

-paranoid subtype may have increased metabolites

Question 30

Role of glutamate in schiz

Answer 30

• antagonists of NMDA receptors aggravate or create psychosis, agonists may relieve symptoms

Question 31

NMDAR hypoactivity hypothesis

Answer 31

If NMDAR proteins are mutated, they become ineffective.
- If they sit on GABA interneurons between cortical GLU neuron and its secondary neuron, a loss of inhibition occurs in the secondary GLU allowing excessive firing and ultimately an increase in firing in the VTA, sending extra DA into the limbic system, causing psychosis

Question 32

DDx of schiz

Answer 32

• psychotic disorder caused by medical condition
• manic phase of bipolar
• substance induced psychosis
• other psychotic disorders

Question 33

Brief psychotic disorder

Answer 33

1-29 days schiz symptoms

Question 34

Schizophreniform disorder

Answer 34

1 month-6 months schiz sx

Question 35

schizoaffective disorder

Answer 35

schizophrenia + mania/depression

Question 36

delusional disorder

Answer 36

delusions but no other schiz sx

Question 37

shared psychotic disorder

Answer 37

one person is delusional and a second person develops the same delusion

Question 38

Medication for schiz

Answer 38

• all effective antipsychotics block D2 receptors in mesolimbic DA path
• lifelong treatment
• typical and atypical antipsychotics
• low compliance due to unpleasant side effects and poor patient insight

Question 39

Typical first generation antipsychotics

Answer 39

High potency: Haloperidol, Low potency: chlorpromazine

- high potency drugs better at binding and sticking to D2 receptors, may cause more side effects

Question 40

Atypical second generation antipsychotics

Answer 40

• Block D2 receptors AND 5HT2a receptors
• first line agents due to fewer negative side effects
• 5HT2a blockade allows DA to flow more freely in the nigrostriatal path (where low DA causes parkinson-y sx)

Question 41

Psychotherapy for schiz

Answer 41

• CBT to improve executive dysfunction, family therapy, Peer and Mentor support or social skills group

Question 42

Prognosis with schiz

Answer 42

• downhill course in 90%
• often stabilizes in midlife w/ more negative symptoms predominating
• suicide is very common

Good prognostic indicators: female, older onset, married, good relationships, positive sx, few relapses, good employment